MEDICARE: DR. PAUL J STANISH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	01042582	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000092005	OTHER	IN	ANTHEM PROVIDER NUMBER
2	90001166	OTHER	IN	BC/BS OF ILLINOIS PROV #
3	020037867	OTHER	IN	RR MCR PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780689984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J STANISH MD

Provider Business Mailing Address
First Line	:	1400 S LAKE PARK AVE
Second Line	:	STE 200
City	:	HOBART
State	:	IN
Zip	:	46342-6791
Country	:	US
Telephone Number	:	219-947-6122
Fax Number	:	219-947-6045

Provider Business Practice Location Address
First Line	:	1400 S LAKE PARK AVE
Second Line	:	STE 200
City	:	HOBART
State	:	IN
Zip	:	46342-6791
Country	:	US
Telephone Number	:	219-947-6122
Fax Number	:	219-947-6045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	04/25/2011

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Directions to “ DR. PAUL J STANISH MD” Practice Location

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